tbuckley/cabot-search huggingface dataset:
Abstract 12835: Predictors of Utilization of Multi-Vessel Percutaneous Coronary Revascularization vs. Bypass Surgery in Patients Hospitalized With Non-ST Wave Elevation Myocardial Infarction and Comorbid End-Stage Renal Disease: A Nationwide Analysis
Authors: Siddharth Agarwal, Agam Bansal, Khawaja Akhtar, Satyam Krishan, Muhammad Faraz Anwaar, Jehanzeb khan, Nikita Garg, Usman Baber
Journal: Circulation (2022)

Introduction: The appropriate strategy for revascularization in patients with coronary artery disease (CAD) and concomitant end-stage renal disease (ESRD) is unknown. The aim of this study was to determine the hospital and patient levels predictors of the type of revascularization strategy pursued in patients hospitalized with non-ST wave elevation myocardial infarction (NSTEMI) and ESRD. Methods: Study cohorts were derived from the Nationwide Inpatient Sample (NIS) 2016-19. Study variables were identified using ICD-10-CM-codes. Patients presenting with cardiogenic shock were excluded. The primary outcomes were the predictors of the type of revascularization strategy pursued. Multivariable logistic regression was used to adjust for potential confounders. Results: There were a total of 87,800 hospitalizations for NSTEMI with comorbid ESRD, out of which 8060 (53%) underwent multi-vessel PCI and 6909 (46%) underwent CABG. Patients undergoing CABG were younger, had a lower proportion of females, and higher burden of comorbidities (including arrhythmias, coagulopathy, valvular heart disease, morbid obesity, and active drug abuse disorder) than those undergoing MvPCI. Multivariate patient-level and hospital-level predictors are demonstrated in Figure 1. As expected, CABG was associated with significantly higher odds of in-hospital mortality (OR:2.01 (1.3-3.1), p&lt;0.01), length of stay (8.9 days longer, p&lt;0.01), and total hospitalization charges (152,527$ higher, p&lt;0.01) as compared to MvPCI. There was no difference in the odds of stroke between both cohorts. Conclusion: Patient-level factors (including female gender, age, comorbidities (arrhythmias, peripheral vascular disease, diabetes, coagulopathy, history of CABG or PCI, prior stroke/TIA), and hospital levels factors (bed size, hospital procedural volume) independently predicted the type of revascularization strategy pursued in patients hospitalized for NSTEMI with ESRD.
Abstract 14350: CVSA Early Career Investigator Award Finalist: Association of Aneurysm Wall Stresses With Diameter Indices and Three-Year Outcomes in Veterans
Authors: Siavash Zamirpour, Yue XUAN, Zhongjie Wang, Axel Gomez, Michael D Hope, JOSEPH LEACH, David Saloner, Julius Guccione, Liang Ge, Elaine E Tseng
Journal: Circulation (2022)

Introduction: Current diameter-based guidelines for ascending thoracic aortic aneurysms do not consistently predict risk of dissection/rupture. Aneurysm wall stresses may better predict risk but correlate weakly with diameter. Our objective was to correlate aneurysm wall stresses with indexed diameters in relation to 3-year all-cause mortality. Methods: Finite element analyses were performed on 255 patients with aneurysms ≥4.0cm. Three-dimensional geometries were reconstructed from computed tomography and models developed accounting for pre-stress geometries. A fiber-embedded hyperelastic material model was applied to obtain circumferential (circ.) and longitudinal (long.) wall stress distributions under systolic pressure. Peak wall stresses were compared across diameter/[body surface area (BSA)] and diameter/[height (ht)] thresholds from the literature. Hazard ratios for 3-year all-cause mortality and surgical aneurysm repair were estimated using cause-specific Cox proportional hazards models. Results: Compared to the 22% cumulative incidence of aneurysm repair at 3 years, indexed diameter indicated repair at baseline in 17/255 (7%) patients, including only 4/230 (1.7%) with diameter &lt;5.5cm. Peak wall stresses did not significantly differ across literature-proposed thresholds for diameter/BSA (circ: p=0.15; long: p=0.18), but did differ for diameter/ht (circ: p=0.003; long: p=0.048). All-cause mortality was associated with peak long. stresses independent of indexed diameter (p=0.009). Peak long. stresses were best predicted by diameter (c-statistic=0.66), followed by diameter/ht (c-statistic=0.59), and diameter/BSA (c-statistic=0.55). Conclusions: Diameter/ht better stratified peak wall stresses than diameter/BSA. Peak long. stresses independently predicted all-cause mortality, adjusting for age and indexed diameter. Peak long. stresses may aid risk stratification for adverse events.
Abstract 12863: Similar Rates of Embolic and Bleeding Events for Direct Oral Anticoagulants and Warfarin in the Treatment of Left Ventricular Thrombus
Authors: Alexander Conant, Yuting Deng, Daniel B Sims
Journal: Circulation (2022)

Introduction: Left ventricular thrombus (LVT) is common post-STEMI, with an incidence of as high as 26% in patients with anterior MI. AHA guidelines recommend systemic anticoagulation with warfarin for patients with LVT. However, the efficacy of direct oral anticoagulants (DOACs) compared to warfarin in the treatment of LVT is unknown. Hypothesis: Rates of embolic events and bleeding will be similar in LVT patients treated with DOACs compared to warfarin. Methods: Retrospective single institution study of all patients with LVT diagnosed between 2010 and 2021 and treated with an anticoagulant. The primary outcome was embolic events (stroke, TIA, and other systemic embolism). Secondary outcomes were all bleeding events, major and minor bleeding per International Society on Thrombosis and Haemostasis criteria, and all adverse outcomes. p&lt;0.05 by Chi-square test was considered significant. Results: Included were 164 patients with LVT who received anticoagulation. Of those, 29 were prescribed DOACs and 135 warfarin. A similar percentage of patients on DOACs and warfarin had embolic events (6.9% and 6.7%, respectively, p=0.97). DOACs had a trend towards lower rates of bleeding events, major and minor bleeding, all adverse outcomes, and percentage of patients experiencing an adverse outcome (10.3% vs 25.2%, p=0.13). Conclusions: LVT patients treated with DOACs had a similar risk of embolic and bleeding events and a trend towards less bleeding compared to those treated with warfarin.
Abstract 12834: Hospital Variation in Implantation of Permanent Pacemaker After Transcatheter Aortic Valve Implantation: An Insight From the US Nationwide Readmission Database
Authors: Alejandro Sanchez-Nadales, Salman Zahid, Dipan Uppal, Antonio Lewis, Jose R Sleiman, Craig R Asher, Jose L Baez-Escudero
Journal: Circulation (2022)

Background: Pacemaker implantation (PPM) remains the most common complication after TAVI. However, the relationship between hospital volume of TAVI discharge and PPM implantation remains unknown. Methods and Results: The purpose of this study was to evaluate the association between annual TAVI discharge volumes with 30-day incidence of PPM implantation. We utilized the most recent available 2018 US Nationwide Readmission Database. International Classification of Diseases ICD-10 codes were used to identify all hospitalizations. We categorized hospitals performing &lt;100 cases per year as low-volume; 100 to 200 as medium-volume and &gt;200 high-volume facilities. A total of 34,740 non-weighted TAVI hospitalizations were included in this analysis. Of the included cases, 37.5% (13,024) were performed in low volume centers, whereas 31.3% (10,862) and 31.2% (10,854) cases were performed in medium and high-volume centers. The overall 30-day rate of PPM Implantations was 19.5% (6,771). On adjusted analysis there was no difference between high (OR 1.01, 95% CI 0.95-1.08) and medium volume (OR 1.02, 95% CI 0.95-1.09) centers when compared to low volume centers respectively. Moreover, cumulative incidence curves showed similar rates of readmission for PPM implantations (Figure 1: P log rank 0.20). Conclusions: PPM implantation rates remain high post TAVI. Higher volume of TAVI discharge does not result in fewer PPM implantations. Further studies and interventions are required to reduce PPM implantation after TAVI.
Abstract 14059: Correlation Between Demographics, Clinical Characteristics, Hemolytic Markers, and Pulmonary Hypertension Confirmed by Invasive Hemodynamics in Sickle Cell Disease
Authors: Rachel Brett, Santosh Saraf, Dawood Darbar, David Tofovic
Journal: Circulation (2022)

Introduction: Pulmonary hypertension (PH) is a common complication and cause of death in sickle cell disease (SCD). Prior study demonstrated poor correlation between the assessment of mean pulmonary artery pressures (mPAP) by echocardiogram (TTE) and right heart catheterization (RHC) in SCD. Yet, most PH studies in SCD have used TTE for the identification of PH. We sought to better characterize the clinical features of symptomatic SCD patients with/without PH confirmed on invasive testing. Methods: All symptomatic, defined as dyspnea or shortness of breath, SCD patients with RHC between 2008-2017 in a single large center in the Chicagoland area were recruited. PH was defined by mPAP &gt; 20 mmHg. Based on World Health Organization PH classification, Group 2 PH was differentiated from Group 1 PH by a pulmonary capillary wedge pressure (PCWP) ≥16 mmHg. Diagnosis and etiology of Group 1 PH was confirmed by chart review. We analyzed categorical and continuous variables using Pearson’s χ2 test and the Student’s t test, respectively, with Bonferroni correction as appropriate. Results: 62 individuals with SCD and invasive hemodynamic testing were identified. All were African American, 37% were female, 90.3% were homozygous SS genotype, and 74.2% were on hydroxyurea ( Table 1 ). Only mean LDH concentration was significantly different in those with PH compared to without (361 vs 448 U/L; P =0.02). Compared to Group 1 PH, those with Group 2 PH were younger (34.5 yr vs. 49 yr.; P =0.01), had higher mPAP (38 mmHg vs. 28 mmHg; P =0.002), had a higher prevalence of hypertension ( P =0.03) and chronic kidney disease ( P =0.004), and were frequently on a diuretic, angiotensin pathway blocking medication, calcium channel blocker, β-blockers, and/or nitrates ( Table 1) . Conclusions: In symptomatic patients with SCD, PH diagnosed on invasive hemodynamics is associated with higher LDH. Those with Group 2 PH tend to be younger, have worse renovascular disease, and require more cardiovascular medications.
Abstract 13959: Role of METTL3 in Regulating Pulmonary Hypertension via Controlling GLUT4 mRNA Translation
Authors: Paramasivam Arumugam, Vijayashree Priyadharsini Jayaseelan, Ganesh M Karthik
Journal: Circulation (2022)

Introduction: N6-methyladenosine (m6A) modification is one of the most prevalent internal modifications of eukaryotic mRNAs, which plays a crucial role in cardiovascular disease via regulating mRNA splicing, stability, and translation. However, the potential role of m6A modification and its regulatory proteins in pulmonary hypertension (PH) remain largely unexplored. Hypothesis: To investigate the role of m6A modification and its regulatory proteins in the pathogenesis of PH. Methods: m6A level and its regulatory proteins were measured in PH rat models after monocrotaline administration or hypoxia-induced. The global mRNA m6A level was measured by an m6A-RNA methylation quantification kit in lung tissues from PH rats. Western blot was used for m6A regulatory proteins expression analysis. Methylated RNA immunoprecipitation sequencing (MeRIP-seq) was performed to analyze the target genes of m6A master regulator METTL3. Pulmonary artery smooth muscle cells (PASMCs) were used for function analysis. Results: m6A level and its regulatory proteins expression including METTL3 were increased in lung tissues from PH rats. m6A RNA immunoprecipitation analysis revealed that GLUT4 as an m6A-regulated gene in PH. Functionally, knockdown of METTL3 reduced expression of GLUT4 and PASMC proliferation. Conclusions: METTL3 promotes PASMC proliferation and PH via enhancing GLUT4 translation in an m6A-dependent manner. This study identified a novel RNA epigenetic mechanism that enhances PASMC proliferation, vascular remodeling, and PH. Thus, m6A modification and its regulatory proteins represent promising therapeutic targets for PH.
Abstract 13819: Case Report of a Mitral Stenosis in a Young Growing Teenager After Rheumatic Mitral Regurgitation Valve Repair
Authors: Neguemadji Ngardig Ngaba, Uzoego N Chibuzo, Meet Patel, Amit Gulati, Imteyaz A Khan, Allarangué Succès, Jean Philippe Lesbre
Journal: Circulation (2022)

Background: Mitral stenosis (MS) is a well- defined slowly progressive complication after mitral valve repair for non-rheumatic mitral regurgitation (MR) in adults. The pubertal growth spurt has potential hemodynamic implications for a mitral valve prosthesis matched prior to surgery for a projected indexed effective orifice area (EOA) using the lower pre-surgical body surface area (BSA) that preceded the growth spurt. The peak height velocity usually occurs at Tanner stage 3 in females and 4 in males. To our knowledge, there are no reports highlighting a rapid increase in Trans-Mitral pressure gradient (TMPG) and decline in mitral valve area (MVA) after rheumatic MR valve repair in an early pubescent child. Case presentation: A 14-year-old female presented with orthopnea, abdominal distension and bilateral lower limb edema. She was cachectic with a BMI (Body Mass Index) in the first percentile, a high-pitched holosystolic murmur most prominent at the cardiac apex, bilateral basal crackles, tender hepatomegaly, pitting pedal edema and jugular venous distension. Her Tanner’s stage was 2. Anti-streptolysin O (ASO) titer was elevated. The transthoracic echocardiography (TTE) revealed loss of the mitral valve central coaptation with leaflet restriction and MR. There was an annular dilatation of the Tricuspid valve and Tricuspid regurgitation (TR). She had AHA/ACC stage D mitral and tricuspid regurgitation. Tricuspid annuloplasty and mitral valve repair for rheumatic MR were respectively performed utilizing Carpentier Edward numbers 30 and 34, appropriate for her pre-surgical BSA. Following the surgery, the murmur of MR resolved and her MVA was 4cm 2 . In the first year after surgery, she attained Tanner’s stage 3, a peak growth velocity of 8.4 cm during that year and her BMI rapidly increased to the 10th percentile. However, towards the end of the year she developed progressive increase in TMPG and a decline in the mitral valve area to 1.2 cm 2 . Conclusion: Growth spurts during puberty can potentially affect MR repair as the Mitral valve prosthesis based on a preoperative BSA is outgrown. There is a need for research for planning, prognostication and development of an optimal, individualized and adaptable approach to MR intervention in early pubescence.
Abstract 13522: Gender Disparities in Low Density Lipoprotein Cholesterol Management Across the Spectrum of Atherosclerotic Cardiovascular Diseases: Insights From the Houston Methodist Cardiovascular Disease Learning Health System Registry
Authors: Izza Shahid, Priyanka Satish, Rakesh Gullapelli, Charlie Nicolas, Nwabunie Nwana, BUDHADITYA BOSE, Shubham Lahan, Shiwani Mahajan, Trisha Roy, Garima Sharma, Julia Andrieni, Steven R Jones, Miguel Cainzos Achirica, Khurram Nasir
Journal: Circulation (2022)

Introduction: Statin utilization for LDL-C lowering remains the cornerstone management strategy to reduce the risk of ASCVD. While lower statin utilization has been reported among women compared to men, contemporary studies evaluating sex disparities in LDL-C management across the spectrum of ASCVD are lacking, particularly across age and racial/ethnic subgroups. We aimed to provide detailed insights into this using data from a large US healthcare system. Methods: Cross-sectional study using data from ∼1.1 million patients aged 18+ years in the Houston Methodist Learning Health System Registry (2016-2022). Prevalent ASCVD including CAD, PAD, and stroke were identified using ICD 10-CM codes. Statin use and dose were identified in the database using ATC codes, and this information was recorded based on medication reconciliation reviews with patients at each clinical encounter. Individuals (n=973,720) without established ASCVD were excluded. Results: The study population consisted of 97,819 patients with prevalent ASCVD (55% men; 45% women, mean age: 69 years, 19% NHB, 12% Hispanic). Women with ASCVD reported lower statin use (64.3% vs 72.6%) and lower high-intensity statin use (29.8% vs 42.5%) compared with men. Women were also less likely to have on-treatment LDL-C &lt;70, and this was true for total ASCVD (21.8% vs 30.6%), CAD (24.9% vs 32.9%), PAD (23.2% vs 32.6%), and stroke (20.9% vs 30.1%). These disparities persisted across age (&lt;45, 45-64, &gt;65 years) and racial/ethnic (NHW, Hispanics, NHB, Asian/Other) strata. Conclusion: Significant gender disparities exist in contemporary LDL-C management among US patients with ASCVD, with women being less likely to receive any and high-intensity statin therapy, and reach the guideline defined goal of LDL-C &lt;70 mg/dL than men across age and racial/ethnic subgroups. These disparities underscore the need for further research to understand their drivers, and targeted systemwide programs to overcome care gaps.
Abstract 13412: Updated Meta-Analysis on Safety and Efficacy of Cerebral Embolic Protection Devices Among Patients Undergoing Transcatheter Aortic Valve Replacement
Authors: Dhan B Shrestha, Jurgen Shtembari, Sandesh Lamichhane, Abinash Baniya, Manoj Shahi, Nadia R Sutton, Pedro A Villablanca
Journal: Circulation (2022)

Introduction: Cerebral embolic protection devices (CEP) have been introduced to capture embolic debris and reduce the risk of stroke during Transcatheter Aortic Valve Replacement (TAVR). Available evidence regarding the safety and efficacy of CEP is inconclusive. Therefore, we aimed to determine the safety and efficacy of CEP use during TAVR. Methods: Major electronic databases were searched for the relevant articles with appropriate search terms. All relevant data from 17 studies were extracted into a standardized form. Statistical analyses were performed using Revman 5.4. Odds Ratio (OR) or mean differences (MD) were used to estimate the desired outcome with a 95% confidence interval (CI). Results: A total of 17 studies involving 204,875 patients (15,880 in the CEP arm and 188,995 in the non-CEP arm) were included. No significant difference in 30-day stroke was observed with the use of CEP between the two groups (OR 0.75, 95% CI 0.55 to 1.03). The use of CEP was associated with a lower odds of 30-day mortality by 39% (OR 0.61, 95% CI 0.53 to 0.70). Based on diffusion weighted-magnetic resonance imaging (DW-MRI), there were no differences in the occurrence of new lesions, the total volume of lesions, and the number of new lesions. In addition, the use of CEP in patients undergoing TAVR was associated with a reduction in major or life-threatening bleeding events (OR 0.89, 95% CI 0.81 to 0.98). No differences were observed in the outcomes of acute kidney injury and major vascular complications between both arms. Conclusion: No significant difference in 30-day stroke was observed with the use of CEP in TAVR patients. The use of CEP was associated with significantly lower odds of 30-day mortality and lower rates of major or life-threatening bleeding compared with no CEP in patients undergoing TAVR. Further studies are needed to confirm current findings
Abstract 14857: Usefulness of Invasive Hemodynamics in the Evaluation of Patients With Paradoxical Low Gradient Severe Aortic Stenosis
Authors: Pranav Jain, Ricardo A Nieves, Daniel L Shpilsky, William Katz, Matthew S Suffoletto, Prem Soman
Journal: Circulation (2022)

Background: Management of patients with paradoxical (ejection fraction &gt; 50%) low gradient (&lt; 40 mm Hg mean) severe (valve area &lt; 1 cm 2 ) aortic stenosis (PLAS) on ECHO is controversial. We studied the role of invasive hemodynamics (CATH) in evaluating these patients. Methods: In this single center retrospective cohort study, patients who underwent CATH for evaluation of PLAS on ECHO were divided into a “concordant” group (CG) when CATH aortic valve area (AVA) was &lt; 1.0 cm 2 and a “discordant” group (DG) when CATH AVA was &gt; 1.0 cm 2 . ECHO features, aortic valve replacement (AVR), and all-cause mortality were compared between the two groups. T-test, Chi-square test, and Kaplan-Meier analysis were performed. P-value of &lt; 0.05 was considered statistically significant. Results: Among 76 PLAS patients who underwent CATH, the AVA was discordant in 21/76 (27.6%). DG patients were younger (72.2 vs. 78.7 y, p = 0.008). Other demographics including the Charlson comorbidity index (CCI) were similar. Dimensionless index (DI) was lower in CG than in DG (0.24 ±0.042 vs. 0.274 ± 0.041, p = 0.002) and % with DI &lt; 0.25 was higher in CG (55.6% vs. 28.7%, p = 0.03). Other ECHO parameters including mean gradient, left ventricular outflow tract (LVOT) diameter, Vmax LVOT, AVA i , stroke volume index, and flow rate (AVA x mean velocity) were not different. More patients underwent AVR in CG (49/55, 89%) compared to DG (12/21, 57%, p = 0.001). Overall survival based on all-cause mortality was similar after AVR in both groups (p = 0.695, median follow up 1105.5 days). In DG, survival was better with AVR than with medical therapy alone (p = 0.049). CCI was not different in patients with AVR versus those without (p = 0.102). Conclusion: ¼ of patients with PLAS on ECHO had discordant AVA on CATH. DI &lt; 0.25 occurred more frequently in the CG cohort. Even in the DG, survival was better with AVR. Clinical Implication: AVR confers a survival advantage in patients with PLAS on ECHO, and should be considered regardless of AVA on CATH.